David R. Federick, D.M.D., M.Sc.D.* University
at Los Angeles, School of Dentistry,
Los Angeles, Calif.
of the provisional (treatment) restoration among the procedures lh e importance required for successful completion of a fixed partial denture is often overlooked. Perhaps the inaccurate assignment of the term “temporary” to the interim restoration has generated the misconception that eventual placement of the permanent restoration will immediately and miraculously remedy the detrimental effects of a poorly conceived and fabricated transitional restoration. A well-made provisional fixed partial denture should provide a preview of the future prosthesis and enhance the health of the abutments and periodontium.l-t The theories and techniques of fabrication for numerous types of provisional restorations abound in the dental literature. Techniques from the fabrication of single-tooth provisional coverage to demanding multiunit provisional acrylic resin splints are presented in depth in many texts and journals.
LITERATURE REVIEW Perhaps the most empirical treatment restoration for full coverage is the prefabricated aluminum or celluloid crown form.“-I1 Talkov” and Adams’” described a technique for attaching individual celluloid crown forms together to obtain a splinting effect. Fritts and Thayerl’ suggested that preformed crowns are seldom morphologically correct and usually require alteration to make them esthetically acceptable and protective. A popular method for fabricating provisional fixed partial dentures and splints is the acrylic resin restoration made either directly over the prepared abutments*ls I23 In-~” or indirectly, utilizing a diagnostic cast.“. 111,w ?‘: Some dentists regard the use of an elastic material, as a medium for curing the acrylic resin, as inadequate and recommend the use of the Omnivac VT to secure an acetate stent over the diagnostic cast.“-“x The superior properties of polycarbonate resin have convinced some dentists to substitute it as the matrix material in lieu of polymethyl methacrylate2Qg 30 Precious and semiprecious metal castings may be employed as provisional resto*Assistant tOmnivac
Professor, Department of Restorative Dentistry. V, Omnidental Corporation, Harrisburg, Pa.
rations when a long period of time is anticipated between preparation of the abutments and delivery of the permanent restorations.llt 31 The most convenient and time-saving method for providing a provisional restoration when multiple units are involved is to have an acrylic resin “shell” splint ready for relining intraorally at the time of abutment preparation. The shell may be made with autopolymerizing acrylic resin?” ‘X2-31or heat-cured resin.359 36 Gold collars may be incorporated in the splints to provide a stronger and possibly more accurate gingival margin than is obtainable with acrylic resin alone.“’ RATIONALE
FOR THE PROVISIONAL
For patients requiring periodontal therapy in conjunction with fixed restorative dentistry, the interim of provisional coverage is critical.2, 22 Prichard38 recognized that a provisional splint may be worn for long periods of time while questionable teeth and supporting structures are evaluated for inclusion in the final prosthesis. With regard to its significance in both periodontal prostheses and rehabilitation, the purposes for the provisional (treatment) restoration are as follows: (1) to protect pulp and sedate prepared abutments, (2) to evaluate parallelism of abutments, (3) to immediately replace missing teeth, (4) to prevent migration of abutments, (5) to improve esthetics, (6) to provide an environment conducive to periodontal health, (7) to evaluate and reinforce the patient’s oral home care, (8) to aid periodontal therapy by providing visibility and access to surgical sites when removed, (9) to provide a matrix for the retention of periodontal surgical dressings, ( 10) to stabilize mobile teeth during periodontal therapy and subsequent repair, ( 11) to anchor orthodontic brackets during minor tooth movement, (12) to aid in developing and evaluating an occlusal scheme before the final prosthesis is made, ( 13) to allow evaluation of vertical dimension, phonetics, and masticatory function, and (14) to aid in determining the prognosis of questionable abutments in the over-all restorative treatment plan. REQUIREMENTS
FOR THE PROVISIONAL
The fabrication of a physiologically acceptable provisional splint requires attention to detail and allocation of adequate time with the patient.3” The treatment restoration must provide an environment conducive to attainment and maintenance of good gingival health. 2, 15, 24, 25, 37, 40, 41 Donaldson42, 43 studied the problems of gingival recession caused by the wearing of temporary crowns and found six factors directly related to incorrect form and contour of acrylic resin crowns having detrimental effects on the marginal gingiva. The basic requirements of a morphologically correct and physiologically compatible provisional restoration are: ( 1) good marginal adaptation, (2) retention and resistance to dislogment during normal masticatory function, (3) strong and durable, (4) nonirritating, (5) nonporous and dimensionally stable, (6) comfortable, (7) esthetic, (8) physiologic contours and embrasures, (9) easy to reline and repair, ( 10) physiologic occlusion, ( 11) kind to the supporting structures and tissues, ( 12) conducive. to routine oral home-care cleaning procedures, (13) highly polished, plaque-resistant surfaces, and ( 14) easy to remove and recement by the dentist.
J. Prosthet. November,
Fig. 1. The maxillary for full crowns.
and first molar
on a Typodont
Fig. 2. The acrylic resin record is in the doughy dont closed in the centric occlusion position.
state over the prepared
Fig. 3. Cusp tips and buccolingual tomic form.
Fig. 4. A carbide bur is used to delineate
have been prepared teeth with
form prior to relining.
A useful, though seldom employed, method for making provisional restorations is the acrylic resin block technique. It provides a means of fabricating the interim restoration without the use of diagnostic casts and laboratory processing costs. The technique requires a knowledge of dental anatomy and the patience and artistic traits inherent in dentists. The fabrication of a three-unit provisional fixed partial denture by use of the acrylic resin block method is described and illustrated on a Typodont. ( 1) The maxillary right first premolar and first molar are prepared for complete crowns (Fig. 1) . (2) Autopolymerizing acrylic resin of the suitable shade is mixed and allowed to set to a doughy consistency (the sheen of surface-free monomer has completely disappeared). After the abutments and surrounding gingiva have been lightly lubricated with petrolatum, the acrylic resin record is placed over the prepared abutments, and the patient is guided to closure in the centric occlusion position (Fig. 2).
Fig. 5. Space is provided in the crowns to accept the reline mix of acrylic carbide bur is used to remove approximately 0.5 mm. of acrylic resin. Fig. 6. The provisional abutments.
Fig. 7. The marginal
mix of acrylic
resin. A No. 6 round
resin has been placed over the
detail is refined with a carbide bur.
Fig. 8. Proper crown contour is achieved of the tissue side of the pontic.
stone. Note the physiologic
(3) The acrylic resin record is removed and replaced a few times during the curing process to minimize the effect of the exothermic heat on the abutments. After polymerization, the occlusal surface of the resin record is analyzed for anatomic design and may be marked with pencil as to cusp location and buccolingual width to facilitate carving the crown forms (Fig. 3). (4) Carbide burs and diamond stones are used to roughly develop contour and form of the provisional restoration (Fig. 4) . (5) Since no impression matrix is used to carry the acrylic resin mix over the prepared teeth, the initial splint must be relined to assure adequate marginal adaptation and integrity. The inside of the crowns is relieved with a round carbide bur to provide space for the relining acrylic resin. The inner surfaces are moistened with monomer and filled with a fresh mix of acrylic resin. The splint is then replaced over the prepared abutments while the acrylic resin reline cures. The patient is again guided to closure in the centric occlusion position (Figs. 5 and 6) . (6) The provisional restoration is carved to correct occlusal anatomy, crown contour, and embrasure form with burs, stones, and discs. This must be done with
J. Prosthet. Dent. November, 1975
Fig. 9. A lingual view of the completed acrylic resin provisional restoration. Fig. 10. The provisional restoration on the Typodont. The darker shade was selected to provide contrast
sufficient care and attention to detail so that it approximates the environment to be established by the final restoration. The provisional splint must be smooth and highly polished (Figs. 7 and 8). (7) The completed provisional restoration is now ready for placement with a temporary cement. Zinc oxide and eugenol cements should be avoided as they tend to soften the acrylic resin on contact and may weaken the restoration (Figs. 9 and IO.). SUMMARY
A discussion of the rationale and requirements of the provisional restoration in fixed prosthetic dentistry has been presented. The importance of this phase of restorative dentistry and a survey of techniques for making interim restorations were gleaned from a review of the literature. A method for the fabrication of a provisional fixed partial denture using an acrylic resin interocclusal record was described and illustrated.
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J. Prosthet. Dent. November, 1975
Prichard, J. F.: Advanced Periodontal Disease, ed. 2, Philadelphia, 1972, W. B. Saunders Company, pp. 885-888. 39. Sochat, P. L., and Schwan, M. S.: The Provisional Splint-Trouble-Shooting, J. South. Calif. Dent. Assoc. 41: 92-93, 1973. 40. Herlands, R. E., Lucca, J. J., and Morris, M. L.: Forms, Contours and Extensions of Full Coverage Restorations in Occlusal Reconstruction, Dent. Clin. North Am., March, 1962, pp. 147-161. 41. Stein, R. S., and Glickman, I.: Prosthetic Considerations Essential to Gingival Health, Dent. Clin. North Am. 4: 177-188, 1960. 42. Donaldson, D.: Gingival Recession Associated With Temporary Crowns, J. Periodontal. 44: 691-696, 1973. 43. Donaldson, D.: The Etiology of Gingival Recession Associated With Temporary Crowns, J. Periodontol. 45: 468-471, 1974. SCHOOL OF DF~TISTR~ UNIVERSITY OF CALIFORNIA AT Los ANGELES THE CENTER FOR THE HEALTH SCIENCES Los ANGELES, CALIF. 90024